日间手术在髋膝关节置换的应用.pptx

Same-Day Discharge in Total Joint Arthroplasty2016级硕士研究生：罗泽宇研究生导师：周宗科教授May, 2018IntroductionThe demand for TJA is increasingFast-track TJA: LOS 3 daysOutpatient: discharged on same day postoperative (less than 12-hour stay) Financial analysisOutpatient TJA would save $300 million annuallyIntroductionSafety is primary factor to be concernedComplication, mortality, readmission and reoperationRisk factor and patient selectionGeneral condition: age, gender, BMIHistorical or current disease: diabetes, cardiac disease , pulmonary disease, renal diseaseSurgical procedureGeneral or regional or spinal anesthesia Standard or mini incisionTourniquet, drainagePerioperative management and discharge Postoperative function and rehabilitation Article #12017 . JBJSLevel of Evidence Level III Retrospective study Article #1Aim: to compare matched cohorts of patients who underwent same-day and inpatient hip or knee arthroplasty in terms of postoperative complications and 30-day readmission rates Design: retrospective matched cohorts studyData source: ACS-NSQIP registry from 517 US hospital from 2005-2014Outcomes: complications, readmission rates General character: 177,818 patients, 1,236 outpatients, 176,582 inpatientsDemographics Adverse eventsAdverse events in THAAdverse events in TKAAdverse events in UKARisk factor of complicationFactorsRelative risk95% confidence interval (CI) P valueBMI35kg/m22.39 1.06 - 5.400.035insulin-dependent diabetes4.021.06-15.300.041non-insulin-dependent diabetes3.271.29-8.340.013Age855.361.09-23.330.039Conclusion No significant differences in overall postoperative complications or readmission were found between matched cohorts of patients who underwent same-day and inpatient hip and knee arthroplastiesLimitationsRetrospective studyThe function was not assessed Risk Factors for Complications and readmission should be given more detailsArticle #22017 . JOALevel of Evidence Level III Retrospective study Article #2Aim: To compare the predictive ability of